PREVALENCE OF SMOKING AMONG MALE

MEDICAL STUDENTS OF SHEIKH ZAYED

MEDICAL COLLEGE
RAHIM YAR KHAN

Submitted By
Batch B, 4th Year MBBS Session (2018-2019)
Department of Community Medicine
Sheikh Zayed Medical College, Rahim Yar Khan
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2
Name of Student: _______________________
Class Roll number: __________________________
University Roll number: _________________________
Signature of Student:____________________________
Signature of Supervisor: _________________________

Supervisor
Prof. Dr. Hafiz Muhammad Yar Malik
HEAD OF DEPARTMENT OF COMMUNITY MEDICINE

Co supervisor
Dr. Ghulam Mustafa, Associate Professor
Dr. Imran Hanif,

DEPARTMENT OF COMMUNITY MEDICINE

SHEIKH ZAYED MEDICAL COLLEGE, RAHIM YAR KHAN

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 BATCH B, 4th YEAR MBBS (2018-2019)

Name Roll No Name Roll No

Nazneen Ali Gohar 412 Atif Mumtaz 512

Shafia Saleem 413 Khizar Hayat 514

Ammara Jabbar 414 Asher Azeem 515

Zainab Ul Ghazali 417 M.Hamza Rohani 516

Ayesha Mumtaz 423 Faisal Habib 517

Zoha Arshad 424 Hafiz Hassan Hanzala 520

Kinza Kanwal 425 M.Usama Aslam 521

Ayesha Zaib Un Nisa 426 Muhammad Shahbaz 522

Rabia Rehman 430 Muhammad Uzair 523

Arfa Batool 431 M.Hassan Raza 525

Rameen Daud 432

Iqra Arif 433

Sameen Saeed 435

Hira Jabbar 436

Ushna Ali 443

Rabia Malik 607

M.Zee Waqar 511

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 TABLE OF CONTENTS

Sr. No Contents Page Number

1 Abstract 6

2 Introduction 7

3 Objectives 15

4 Methodology 16

5 Results 18

6 Discussion 24

7 Conclusion 31

8 References 32

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 ABSTRACT
BACKGROUND: Smoking is an emerging problem among medical students. The pattern

and extent of the problem varies from place to place. OBJECTIVE: To assess the

prevalence of smoking among male medical students of Sheikh Zayed Medical college

R.Y.Khan. METHODOLOGY: Study design: Cross sectional Study. Study subjects:

Study was carried out among male medical students of SZMC from 1st year to final year

MBBS. Sample size; 150 students, 30 from each class. Place and Duration of study:

Data was collected in a period of one month from 20th May 2019 till 20th June 2019 in

SZMC. Performa was designed by students of Batch B with the help of our batch teacher.

Before commencing the data Collection informed verbal consent was taken from all study

subjects. All the data was recorded on performa. The performa contained variables like

class, age, socioeconomic status, initiating factors of smoking,number of cigarettes

smoked per day, smoking status, time period of smoking and plans to quit smoking. The

data was entered on SPSS version 22 and results were presented as percentage,

mean,±S.D. RESULTS : According to this study 22% male students were current

smokers. CONCLUSION: The study concluded that one in five male medical students

were current smokers. Friends were most common source of initiating smoking. This

study showed that 12% of the male medical students suggested that increasing the price

of cigarette can reduce smoking habbits and 14% suggested counseling. KEY WORDS:

Prevalence,Descriptive cross sectional study.

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 Introduction

Tobacco smoking is the practice of smoking tobacco and inhaling tobacco smoke
(consisting of particle and gaseous phases). (A more broad definition may include
simply taking tobacco smoke into the mouth, and then releasing it, as is done by some

with tobacco pipes and cigars.)[1] The practice is believed to have begun as early as

5000–3000 BC in South America.[2,3] Smoking is the most common method of

consuming tobacco, and tobacco is the most common substance smoked. The
agricultural product is often mixed with additive and then combusted. The resulting
smoke is then inhaled and the active substances absorbed through the alveoli in the
lungs or the oral mucosa.Combustion was traditionally enhanced by addition of
potassium or nitrates.Cigarettes,French for "small cigar", are a product consumed
through smoking and manufactured out of cured and finely cut tobacco leaves and
reconstituted tobacco, often combined with other additives, which are then rolled or
stuffed into a paper-wrapped cylinder.Cigarettes are ignited and inhaled, usually through
a cellulose acetate filter, into the mouth and lungs.Many substances in cigarette moke
trigger chemical reactions in nerve endings, which heighten heart rate, alertness and
reaction time, among other things.
As of the record, tobacco is used by about 49% of men and 11% of women aged 15 or
older in low-income and middle-income countries. with about 80% of this usage in the
form of smoking. .Data from recent studies confirm the quantitative relationship between
smoking and many health hazards in the form of premature death and serious
morbidity.Unfortunately, smoking is on the rise in most developing countries, including
Pakistan, whereas in most developed countries there is a steady decline in its
[4,5]
prevalence . Cigarette production has been increasing worldwide at an average of

2.2% each year, outpacing the population growth rate of 1.7%.According to a World
Health Organization (WHO) report, tobacco use is predicted to cause 10 million deaths
annually by the year 2030. Since smoking has a serious impact on public health,
[6,7,8].
prevention programs have been given high priority
7
to WHO policies
Many smokers begin during adolescence or early adulthood.During the early stages, a
combination of perceived pleasure acting as positive reinforcement and desire to
respond to social peer pressure may offset the unpleasant symptoms of initial use, which
typically include nausea and coughing. After an individual has smoked for some years,
the avoidance of withdrawal symptoms and negative reinforcement become the key
motivations to continue.The most common factor leading students to smoke is cigarette
advertisements. Smoking by parents, siblings and friends also encourages students to
smoke. Smoking has elements of risk-taking and rebellion, which often appeal to young
people. The presence of high-status models and peers may also encourage smoking.
Because teenagers are influenced more by their peers than by adults, attempts by
parents, schools, and health professionals at preventing people from trying cigarettes are
[9].
not always successful

Smokers often report that cigarettes help relieve feelings of stress. However, the stress
levels of adult smokers are slightly higher than those of nonsmokers. Adolescent
smokers report increasing levels of stress as they develop regular patterns of smoking,
and smoking cessation leads to reduced stress. Far from acting as an aid for mood
control, nicotine dependency seems to exacerbate stress. This is confirmed in the daily
mood patterns described by smokers, with normal moods during smoking and worsening
moods between cigarettes. Thus, the apparent relaxant effect of smoking only reflects

the reversal of the tension and irritability that develop during nicotine depletion [10,11].
Dependent smokers need nicotine to remain feeling normal. Smoking, primarily of
tobacco, is an activity that is practiced by some 1.1 billion people, and up to 1/3 of the
adult population.The image of the smoker can vary considerably, but is very often
associated, especially in fiction, with individuality and aloofness. Even so, smoking of
cigarette can be a social activity which serves as a reinforcement of social structures
and is part of the cultural rituals of many and diverse social and ethnic groups. Many
smokers begin smoking in social settings and the offering and sharing of a cigarette is
often an important rite of initiation or simply a good excuse to start a conversation with
strangers in many settings; in bars, night clubs, at work or on the street. Lighting a
cigarette is often seen as an effective way of avoiding the appearance of idleness or
mere loitering. For adolescents, it can function as a first step out of childhood or as an
act of rebellion against the adult world. Also, smoking can be seen as a sort of
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camaraderie. It has been shown that even opening a packet of cigarettes, or offering a
cigarette to other people, can increase the level of dopamine (the "happy feeling") in the
brain, and it is doubtless that people who smoke form relationships with fellow smokers,
in a way that only proliferates the habit, particularly in countries where smoking inside
public places has been made illegal. Other than recreational drug use, it can be used to
construct identity and a development of self-image by associating it with personal
experiences connected with smoking. The rise of the modern anti-smoking movement in
the late 19th century did more than create awareness of the hazards of smoking; it
provoked reactions of smokers against what was, and often still is, perceived as an
assault on personal freedom and has created an identity among smokers as rebels or

outcasts, apart from non-smokers [12].

Harmful consequences : No matter how it is smoked,tobacco is dangerous to the

health. There are no safe substances in any tobacco products, from acetone and tar to
nicotine and carbon monoxide. The substances inhaled don’t just affect lungs,they can
affect your entire body.Smoking can lead to a variety of ongoing complications in the
body, as well as long-term effects on the body systems. While smoking can increase
the risk of a variety of problems over several years, some of the bodily effects are
immediate. Learn more about the symptoms and overall effects of smoking on the
body below.In Pakistan, the mortality rate for smokers is three times that of people who
never smoked. In fact, the institutes say that smoking is the most common
"preventable cause of death" in the Pakistan. While the effects of smoking may not be
immediate, the complications and damage can last for years. The good news is that
[13,14]
quitting smoking can reverse many effects.

Effects of nicotine : One of the ingredients in tobacco is a mood-altering drug called

nicotine. Nicotine reaches the brain in mere seconds and makes the smoking person
feel more energized for a while. But as that effect wears off, the person feel tired and
crave more. Nicotine is extremely habit-forming,which is why people find smoking so
difficult to quit.Physical withdrawal from nicotine can impair the cognitive functioning
and makes the smoker feel anxious, irritated, and depressed. Withdrawal can also
cause headaches and sleep problems.The effects of nicotine, like those of other drugs
with potential for abuse and dependence, are centrally mediated. The impact of
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nicotine on the central nervous system is neuroregulatory in nature, affecting
biochemical and physiological functions in a manner that reinforces drug-taking
behavior. Dose-dependent neurotransmitter and neuroendocrine effects occur as
plasma nicotine levels rise when a cigarette is smoked. Circulating levels of
norepinephrine and epinephrine increase, and the bioavailability of dopamine is altered
as well. Among the neuroendocrine effects are release of arginine vasopressin, beta-
endorphin, adrenocorticotropic hormone, and cortisol. Notably, several of these
neurochemicals are psychoactive and/or known to modulate behavior. Thus, affective
states or cognitive demands may be favorably modified (at least temporarily) by
nicotine intake. When nicotine is inhaled, the neuroregulatory effects just described are
[11]
immediately available and the reinforcing effects of the drug are maximized

Effects on body system : When the smoke is inhaled substance that is taken can
damage the lungs. Over time, this damage leads to a variety of problems. Along with
increased infections, people who smoke are at higher risk for chronic nonreversible
lung conditions such as emphysema, the destruction of the air sacs in lungs, chronic
bronchitis, permanent inflammation that affects the lining of the breathing tubes of the
lungs, chronic obstructive pulmonary disease (COPD), a group of lung diseases and
lung cancer. Withdrawal from tobacco products can cause temporary congestion and
respiratory discomfort as your lungs and airways begin to heal. Increased mucus
production right after quitting smoking is a positive sign that your respiratory system is
recovering.Children whose parents smoke are more prone to coughing, wheezing, and
asthma attacks than children whose parents don’t. They also tend to have higher rates
of pneumonia and bronchitis.irritation of the trachea (windpipe) and larynx (voice box).
Smoking causes reduced lung function and breathlessness due to swelling and
narrowing of the lung airways and excess mucus in the lung passages, impairment of
the lungs’ clearance system, leading to the build-up of poisonous substances, which
results in lung irritation and damage, increasedrisk of lung infection and symptoms such
[12]
as coughing and wheezing and permanent damage to the air sacs of the lung .

Smoking damages the entire cardiovascular system. Nicotine causes blood vessels
to tighten, which restricts the flow of blood. Over time, the ongoing narrowing, along with
damage to the blood vessels, can cause peripheral artery disease.Smoking also raises
blood pressure, weakens blood vessel walls, and increases blood clots. Together, this
raises the risk of stroke.There is also the risk of worsening heart disease if someone
10
already had heart bypass surgery, a heart attack, or a stent placed in a blood
vessel.raised blood pressure and heart rate constriction (tightening) of blood vessels in
the skin, resulting in a drop in skin temperature. The less oxygen carried by the blood
during exercise ‘stickier’ blood, which is more prone to clotting.Cigarette smoking causes
damage to the lining of the arteries, which is thought to be a contributing factor to
atherosclerosis (the build-up of fatty deposits on the artery walls) reduced
blood flow to extremities (fingers and toes), increased risk of stroke and heart attack
due to blockages of the blood supply greater susceptibility to infections such as
pneumonia and influenza and lowers the levels of protective antioxidants (such as
vitamin C), in the blood smoking also has an effect on insulin, making it more likely
that who smokes can develop insulin resistance. That puts an increased risk of type 2
diabetes and its complications, which tend to develop at a faster rate than in people
who don’t smoke Nicotine affects blood flow to the genital areas of both men and
women. For men, this can decrease sexual performance. For women, this can result
in sexual dissatisfaction by decreasing lubrication and the ability to reach orgasm.
Smoking may also lower sex hormone levels in both men and women. This can
.[13]
possibly lead to decreased sexual desire

Fingernails and toenails aren’t immune from the effects of smoking. Smoking increases
the likelihood of fungal nail infections.Hair is also affected by nicotine. An older study
found it increases hair loss, balding, and graying.Smoking increases the risk of mouth,
throat, larynx, and esophagus cancer. Smokers also have higher rates of pancreatic
cancer. Even people who “smoke but don’t inhale” face an increased risk of mouth
cancer.
What is second hand smoke : Even if someone is not puffing on cigarettes in the
office (or other worksite), the colleagues can still be impacted. Smoking can decrease
productivity on the job, plus all those potential medical complications linked to smoking.
Heart disease, diabetes, and reduced immune function (to name just a few) can cause
the smoker to take more time off than a non- smoking colleagu.Secondhand smoke
contains over 7,000 chemical. Breathing in secondhand smoke—whether it’s from a
neighbor’s burning cigarette or from a cigarette outside window—has been shown to
have instant effects on the nearby individuals. Over time, secondhand smoke takes a toll
on people’s lungs and has been found to increase the risk of stroke in those exposed by
[14,15].
20-30%
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Passive smoking : Passive smoking is the usually involuntary consumption of
smoked tobacco. Second-hand smoke (SHS) is the consumption where the burning end
is present, environmental tobacco smoke (ETS) or third-hand smoke is the
consumption of the smoke that remains after the burning end has been extinguished.
Because of its negative implications, this form of consumption has played a central role
in the regulation of tobacco products [16].

Effects on family members : Lighting up cigarette around the family increases their
risk of developing ear infections, asthma, and other breathing complications—like
coughs, shortness of breath, and even bronchitis. Children who grow up watching their
parents smoke are also more likely to become smokers as teens. Being an adult, of
course, doesn’t protect anyone from the damaging effects of cigarettes. The lungs and
hearts of all family members in the home are put at risk by secondhand smoke, no
matter how wide someone keeps the windows open—or how many fans he make use
of.Smoking not only impact the smoker's health, but also the health of those around
who don’t smoke. Exposure to secondhand smoke carries the same risk to a
nonsmoker as someone who does smoke. Risks include stroke, heart attack, and heart
disease.The more obvious signs of smoking involve skin changes. Substances in
tobacco smoke actually change the structure of the skin. A recent study has shown that
smoking dramatically increases the risk of squamous cell carcinoma [17]

Smoking decreases efficiency in studies : College students might want to think

twice before lighting a cigarette: a new study shows that smoking during adolescence
can affect cognition and decision-making.It is found that the pre- frontal cortex, which
controls higher cognition, including the ability to make good decisions and think about
future consequences, was less active in adolescents with greater addictions to nicotine,
suggesting that smoking affects brain development and function.As the prefrontal
cortex continues to develop during the critical period of adolescence, smoking may
influence the trajectory of brain development and affect the function of the prefrontal
corex.If severely affected,students might have an impeded ability to make rational
judgments, including the choice to stop smoking.Smoking not only affects th health of
the student, but also decreases the focus an causes loss of concentration.They remain
in a state of confusion and lethargy. This decreases their efficiency in the studies and
hence compromising their future.

Effects on social life and extracurricular

12 activites : As students smoke, the loose
their stamina and become inactive in the sports and other extracurricular activities.This
causes a decrease in their social circle and activities that freshen the mind.The habit of
smoking ultimately drives them back and back and there is loss of their health and
studies.So their competency in their field will be compromised in long terms.Students
are also affected financially to some extent.As they put their money for buying
cigarettes, they run out of money and hence they giveup the other healthy dietry
products like fresh juices, milk etc. They may want to consume them, but they remain no
longer able to afford these products. Moreover, students usually suffer from acute
pharyngitis and fever caused by irritation due to cigarette smoke. So they need to pay
for the drugs from their pocket money and that seems to be an extra burden on them
[18].

Role of health professionals in smoking cessation : Health professionals

educate their patients on the hazards of smoking. They usually serve as role models for
their patients and the public and, therefore, play an important role in discouraging people
from smoking. The participation of Health professionals in prevention and cessation
counseling could be part of the strategies to minimize tobacco-related deaths in the
future. For health professionals to convince others, they should be nonsmokers.They
counsel the smokers by addressing to them that deciding to quit smoking is only half the
battle. Knowing where to start on the path to becoming smoke-free can help to take the
leap.Quitting smoking is not a single event that happens on one day; it is a journey. By
quitting, a person will improvehis health and the quality and duration of his life, as well as
the lives of those around him. To quit smoking,a smoker not only needs to alter his
behavior and cope with the withdrawal symptoms experienced from cutting out nicotine,
buthe also need to find other ways to manage his moods.With the right game plan,a
smoker can break free from nicotine addiction and kick the habit for good.There are
several ways to stop smoking, but ultimately,the person needs to decide whether he is
going to quit abruptly, or continue smoking right up untilhis quit date and then stop.Here
are som tips that are given to a smoker to help him quit the smoking [19,20].

Counselling and interventions to quit smoking: He is advised to tell friends,

family, and co-workers about his quit date, throw away all cigarettes and ashtrays.decide
whether he is going to go "cold turkey" or use nicotine replacement therapy, set up a
support system, such as a family member that
13 has successfully quit and is happy to help
you.Breaking the association between the trigger and smoking is a good way to help you
to fight the urge to smoke.The person is asked to stay busy, begin use of his NRT if he
has chosen to use one, attend a stop-smoking group or follow a self-help plan, drink
more water and juice, drink less or no alcohol, avoid individuals who are smoking. On the
other hand, nicotine gum and most other nicotine replacement vehicles in current use
have a slower onset of action, resulting in less reinforcement value. Recent data suggest
that smoking cessation rates may be optimized by tailoring the dose of nicotine
replacement (for example, 2 or 5 mg of nicotine gum) to the individual degree of nicotine
dependence. In view of the dynamic interactions between the neuroregulatory effects of
nicotine and a host of environmental conditions, nicotine replacement therapy is best
carried out in combination with behavior modification techniques.NRT can reduce the
cravings and withdrawal symptoms that may hinder the attempt to give up smoking
[21,22]. NRTs are designed to weanthe body off cigarettes and supply with a controlled
dose of nicotine while sparing a person from exposure to other chemicals found in
tobacc. Bupropion and veriniciline are also used for this purpose. Risks involved with
using these drugs include behavioral changes, depressed mood, aggression, hostility,
and suicidal thoughts or actions.The emotional and physical dependence on smoking
makes it challenging to stay away from nicotine after quitting the smoking. To quit, there
is need to tackle this dependence. Trying counseling services, self-help materials, and
support advices can help to get through this time. As physical symptoms get better over
time, so will be emotional ones. Combining medication - such as NRT, bupropion, and
varenicline - with behavioral support has been demonstrated to increase the chances of
long-term smoking cessation by up to 25 percent [23].
Role of medical students : As future physicians, medical students are considered a
primary target of tobacco prevention programs. They can therefore, play a positive role
in preventing smoking among people in their community. They may deliver health
education, support anti-smoking policies and influence national and global tobacco
control efforts.Previous studies in Pakistan of medical students, in government colleges,
showed that smoking was highly prevalent among male students.This study aimed to
determine the prevalence of smoking of medical students at the Sheikh Zayed Medical
College and assess the association between smoking and sociodemographical factors,
contacts with smokers, reasons for smoking and attempts to stop smoking It is hoped
that the results would help with the planning of corrective measures, as necessary.
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 Objectives

The objective of this study were to:

• Assess the prevalence of smoking among the male medical students of

Sheikh Zayed Medical College, Rahim Yar Khan.
• Determine the source of initiation of smoking.

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 Methodology
Study Design:

Cross Sectional Study

Study Setting:

This study was conducted in boys hostels, Sheikh Zayed Medical College R.Y.Khan.

Study Subject:

Male Medical Students

Study Duration:

From 20th May 2019- 20th June 2019

Sample Size:

150 male medical students were included in the study.

Sampling Technique :

Convenient Sampling Technique

Inclusion Criteria:

1. Male Medical students who were willing to give data.

2. Only Male MBBS students were included.

Exclusion Criteria:

1- Students not willing to participate in study.

2- The students other than MBBS students.

Data Collection Method:

Data was collected on predesigned questionnaire. Data was collected from these
students by convenient sampling technique following inclusion and exclusion criteria.
Pretesting of questionnaire was done for data collections, which comprised of

16
different variables such as age, socioeconomic status (Poor class having monthly
income < Rs.15000, Middle Class having monthly income < Rs.50000. and upper
class having monthly income > Rs.50000) source of initiation of smoking, duration of
smoking, and impact of medical college on smoking habit were included.

Data Analysis:

The data was entered and analyzed by using SPSS version -22. Numerical variables
like age were presented as mean ± SD and categorical variables like smoking status
were presented as percentages.

Ethical Approval:

Ethical approval was sought from “Institutional Review Board” before starting
research.

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 Results
This study was conducted to assess the prevalence of smoking among male medical
students.
Table 1: Age wise distribution of study subjects

Frequency Percentage
Age

18-19 years 40 26.66%

19-20 years 60 40.0%

20-21 years 30 20%

>22 years 20 13.33%

Total 150 100%

Table 1 shows That the maximum Percentage (40%) of students is between the 19
to 20 years. Mean Age was 19.6 years. Median was 20 years
Table 2: Class wise distribution of study subjects:

Class No Percentage
1st year 30 20.0%
2nd year 30 20.0%
3rd year 30 20.0%
4th year 30 20.0%
final year 30 20.0%
Total 150 100%

Table 2 shows that 30 (20%) students were taken from each class.

18
 Table 3: Socio Economic class wise distribution of study subjects:

Socio-Economic Class Number Percentage

Poor class 12 8%
Middle class 134 89.3%%

Upper class 4 2.7%%

Total 150 100%

Table 3 shows that the highest percentage of study subjects were from middle class
that is 134 (89.3%)

Table 4: Distribution of study subjects according to their smoking status

Smoking status Frequency Percentage

Non smokers 102 68%
Daily smoker (at least 1 33 22%
cigarette/day)
Occasional smoker (1-2 15 10%
cigarette /week)
Total 150 100%

Table 4 shows that about 22 % of study subjects were Daily Smokers.

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 Table 5: Distribution of study subjects According to their initiation of smoking

Percentage
Initiation Frequency
77.1%
Friend 37
8.3%
Cousin 4
14.6%
Any other person 7
100%
Total 48

Table 5 shows that the source of majority of smokers, about 77.1%, was their friend.

Table 6: Distribution of study subjects according to the number of cigarettes

they smoke per day

Per day distribution Frequency Percentage

Less than 5 cigarettes per day 19 39.6%
5-10 cigarettes/day 13 27.1%
10-15 cigarettes/day 13 27.1%
20 or more 3 6.2%
Total 48 100%

Table 6 shows that about 39.6% of smokers smoked less than 5 cigarettes per day.

20
 Table 7: Distribution of study subjects according to the time period of their
smoking:

Time period Frequency Percentage

<1 year 14 29.2%

1-2 years 13 27.1%

3-5 years 17 35.4%

5-10 years 4 8.3%

Total 48 100%

Table 7 shows that 17 (35.4%) Study subjects had been smoking for 3-5 years.

Table 8: Distribution of the study subjects according to their Effect of smoking

habits after their admission in medical college:

Effect on Smoking habit Frequency Percentage

No change 3 6.3%
Smoke 25-50% more 16 33.3%
Double smoking habit 26 54.1%
Quit smoking 3 6.3%
Total 48 100%

Table 8 shows that highest percentage of smokers that is 54.1% doubled their
smoking habit after admission in medical college.

21
 Table 9: Distribution Of study subjects according to their Plan to Quit
Smoking:

Plan to quit smoking Frequency Percentage

Yes 24 50%
No 24 50%
Total 48 100%

Table 9 shows That half of the smokers (50%) planned to quit smoking.

Table 10: Distribution of Study Subjects According To Their Monthly

Expenditure On Smoking:

Percentage of pocket money Frequency Percentage

<5% 20 41.7%
10% 9 18.7%
15% 6 12.5%
>20% 13 27.1%
Total 48 100%

Table 10 shows that majority of smokers that is 41.7% spent less than 5% of their
pocket money on smoking.

22
 Table 11: Distribution of Study Subjects according to Awareness about Harms
of smoking:

Awareness about harms Frequency Percentage

Yes 44 91.7%
No 4 8.3%
Total 48 100%

Table 11 shows that 91.7% of smokers were aware of harmful effects of smoking.

Table 12: Distribution of study subjects according to the methods by which

they can reduce smoking:

Possible methods to reduce Frequency Percentage

smoking
Placing health warning on 1 2.1%
cigarette packet
Increasing price of cigarette 18 37.5%
Anti-smoking education 8 16.7%
programs
Counseling of smoker 21 43.7%
Total 48 100%

Table 12 shows that 43.7% (highest percentage) of smokers thought that they could
reduce smoking through counseling.

23
 Discussion
Smoking among medical students can results in health, social and
education related issues. Our study showed that 30 (20%) study subjects were taken
from each class. mean age was 21.6±2 years and smoking prevalence among male
students was 31.3%. Our study showed that 134 (89.3%) study subjects were from
middle class, followed by 12 (8%) from poor class and 4 (2.7%) from upper class.

The cross-sectional study in Lebanon (25) reported the prevalence of

tobacco use and associated knowledge and behavior among medical students in
2009-10 from 6 medical schools in Lebanon. The self administered questionnaire
based on the global health professional survey (GHPSS). Core questions aloes
inquired about training in tobacco cessation approaches. All enrolled students were
asked to participate. The response rate was 191/354 (54.3%). According to study in
Lebanon, 191 study subjects were taken from 6 medical schools. 144 (75.3%)
subjects were from middle class followed by 15 (7.85%) were from poor class and
32 (16.75%) were from upper class. Our study showed that 103 (68.7%) study
subjects were nonsmoker (never smoked), followed by 33 (22%) were daily
smokers, 11 (7.3%) were occasional smokers and 3(2%) were ex-smokers. The
study conducted in Lebanon showed that 26.3% of study subjects were smokers
whereas 73.7% of study subjects who responded were non-smokers.

The study conducted in our medical college showed that the source of
smoking of 37 (24.7%) were their friends and the sources of remaining 7 (4.7%) and
4 (2.7%) study subjects were any other person and their cousin respectively
whereas study of Lebanon showed that 16 (33%) of the study subject had their
source of smoking as friends followed by 10 (20%) as cousins whereas remaining 24
(48%) study subjects had source different than mentioned above. The study we
conducted showed that 102 (68%) study subjects were nonsmokers, 19 (12.7%)
used to smoke not more than 5 cigarettes followed by 13 (8.7%) used to smoke 5-10
and 10-15 cigarettes per day respectively and 3 (2%) used to smoke 20 or more
cigarettes per day. 17 (11.3%) study subjects were smoking for 3-5 years followed

24
by 14 (9.3%) and 13 (8.7%) were smoking for < 1 year and 1-2 years respectively
and 4 (2.7%) were smoking for 5-10 years. 60 (40%) study subjects were in the age
range of 19-20 years, 40 (26.6%) were 18-19 years and remaining 30 (20%) and 20
(13.3%) study subjects were between 20-21 years and more than 22 years
respectively.

According to study conducted in Lebanon, 61% of smoker smoked a

pack of cigarettes daily, whereas 34% of smokers smoked 5-10 cigarettes per day
and 5% of smokers smoke less than 5 cigarettes per day. The age range among
Lebanese smokers was between 21-26 years with the average age of 23.6 years.
Our study showed that 22 (14.7%) study subjects used to smoke to relieve their
tension/anxiety/stress ,14 (9.3%) used to smoke as a fashion and remaining 8
(5.3%) and 4 (2.7%) used to smoke to enhance their sensory stimulation and
because of their peer pressure respectively. 26 (17.3%) study subjects doubled their
smoking habit, 16 (10.7%) increased their smoking habits 25-50% more and
remaining 3 (2%) quit smoking and did not change their habit respectively.
According to study in Lebanon, 34% smokers used to smoke to relieve their
tension/anxiety/stress. While 20% of smokers used to smoke as a fashion. And
remaining 46% of subjects were doing it for any other reason. 30% of the smokers
doubled their smoking habit is medical school while 20% of the smokers increased
their smoking habit and remaining 50% smokers did not change their smoking habit
in medical school.

Our study shows That 24 (16%) are Planning to quit smoking and 24
(16%) have no plan to quit. 20 (13.3%) study subjects Spent <5% on smoking
followed by 13 (8.7%) Spent more than 20% and 9 (6%), 6 (4%) study subjects
Spent 10% and 15% of their money respectively. 44 (29.3%) study subjects were
aware of harms and dangers of smoking and remaining 4 (2.7%) were not aware. 18
(12%) study subject quit smoking because of inflation, 21 (14%) quit due to
counseling and 8 (5.3%) and 1 (0.7%) quit due to antismoking education programs
and placing health warning on cigarette packet respectively. While according to
study conducted in Lebanon , 38% of smokers are planning to quit smoking whereas
remaining 62% of smokers have no plan to quit smoking. , more than half of study

25
subjects spent almost 200-400 US $ of their monthly expenditures on smoking. And
94.2% of study subjects were aware of harmful effects of smoking. 38% of study
subjects were willing to quit this habit.

The research was conducted about cigarette smoking among medical students in
The Nation Ribat University, Sudan(26), 414 medical students responded by filling
their questionnaire out of which 240 students were from first year while 174 students
were from group of 18-23 years. Mean age was 21± 2. Most of the
students were living with their families and about 13% of them live in the boarding
houses. the study revealed that 16 out of 240 (6.6%) in the first year were smokers
while 25 out of 185 students in the final year (14.4%) were smokers. 25 of all
smokers had at least one family member who smoked while 116 out of 375 provided
history of family smoking.

Smoking among medical students can results in health, social and

education related issues. Our study showed that 30 (20%) study subjects were taken
from each class. Mean age was 21.6±2 years and smoking prevalence among male
students was 31.3%. Our study showed that 134 (89.3%) study subjects were from
middle class, followed by 12 (8%) from poor class and 4 (2.7%) from upper class.
According to study conducted in National Ribat University, 414 study subjects were
taken out of which 10% smoked. Mean age of smokers was 21± 2. Among the
smokers, about 65% subjects were from middle class, 24% were from upper class
and 11% were from poor class.

. Our study showed that 103 (68.7%) study subjects were nonsmoker
(never smoked), followed by 33 (22%) were daily smokers, 11 (7.3%) were
occasional smokers and 3(2%) were ex-smokers. According to study in Sudan, 90%
of the study subjects were non-smokers. Among 10% smokers, 7.5% were heavy
smokers (one pack a day) and remaining 2.5% smoked less than 10 cigarettes per
day.

The study conducted in our medical college showed that the source of
smoking of 37 (24.7%) were their friends and the sources of remaining 7 (4.7%) and

26
4 (2.7%) study subjects were any other person and their cousin respectively while
smokers in Sudan 60% had friends as their source, 25% had cousin as their source
while remaining 15% had any other source for smoking.

The study we conducted showed that 102 (68%) study subjects were
nonsmokers, 19 (12.7%) used to smoke not more than 5 cigarettes followed by 13
(8.7%) used to smoke 5-10 and 10-15 cigarettes per day respectively and 3 (2%)
used to smoke 20 or more cigarettes per day. 17 (11.3%) study subjects were
smoking for 3-5 years followed by 14 (9.3%) and 13 (8.7%) were smoking for < 1
year and 1-2 years respectively and 4 (2.7%) were smoking for 5-10 years. 60 (40%)
study subjects were in the age range of 19-20 years, 40 (26.6%) were 18-19 years
and remaining 30 (20%) and 20 (13.3%) study subjects were between 20-21 years
and more than 22 years respectively. According to study conducted in Sudan,
among 10% smokers, 7.5% were heavy smokers (one pack in a day) and remaining
2.5% smoked less than 10 cigarettes per day. 19 (48%) of smokers had history of
smoking for past one year and 12 (28%) of smokers had history of smoking for past
3-5 years and remaining 10 (24%) of smokers had history of smoking for past 5 to
10 years.

Our study showed that 22 (14.7%) study subjects used to smoke to

relieve their tension/anxiety/stress ,14 (9.3%) used to smoke as a fashion and
remaining 8 (5.3%) and 4 (2.7%) used to smoke to enhance their sensory
stimulation and because of their peer pressure respectively. 26 (17.3%) study
subjects doubled their smoking habit, 16 (10.7%) increased their smoking habits 25-
50% more and remaining 3 (2%) quit smoking and did not change their habit
respectively. According to study in National Ribat University, 13 (32%) of smoker
used to smoke in order to relieve their tension/anxiety/stress. And 9 (21%) of
smokers used to smoke as a fashion. And remaining 19 (47%) of smokers used to
smoke in order to enhance their sensory stimulation and because of their peer
pressure.

27
 Our study shows that 24 (16%) are planning to quit smoking and 24
(16%) have no plan to quit. 20 (13.3%) study subjects spent <5% on smoking
followed by 13 (8.7%) spent more than 20% and 9 (6%), 6 (4%) study subjects spent
10% and 15% of their money respectively. 44 (29.3%) study subjects were aware of
harms and dangers of smoking and remaining 4 (2.7%) were not aware. 18 (12%)
study subject quit smoking because of inflation, 21 (14%) quit due to counseling and
8 (5.3%) and 1 (0.7%) quit due to antismoking education programs and placing
health warning on cigarette packet respectively. According to study in National Ribat
University, 81% of smokers tried to quit smoking more than 3 times because 37% of
quitters thought of dangers of addiction and 40% of quitters thought of effects of
smoking on health and 23% did so because of pressure from others.

Smoking among medical students can results in health, social and education
related issues. Our study showed that 30 (20%) study subjects were taken from
each class. mean age was 21.6±2 years and smoking prevalence among male
students was 31.3%. Our study showed that 134 (89.3%) study subjects were from
middle class, followed by 12 (8%) from poor class and 4 (2.7%) from upper class.
[17]
While the study conducted in Egypt , 252 subjects were taken and 12% among
them were smokers. 13.1% of those smokers were heavy smokers.

. Our study showed that 103 (68.7%) study subjects were nonsmoker
(never smoked), followed by 33 (22%) were daily smokers, 11 (7.3%) were
occasional smokers and 3(2%) were ex-smokers. Study in Egypt [17] showed that
88% of study subjects were non-smokers and 6.3% were ex-smokers.

The study conducted in our medical college showed that the source
of smoking of 37 (24.7%) were their friends and the sources of remaining 7 (4.7%)
and 4 (2.7%) study subjects were any other person and their cousin respectively..
The study we conducted showed that 102 (68%) study subjects were nonsmokers,
19 (12.7%) used to smoke less than 5 cigarettes followed by 13 (8.7%) used to
smoke 5-10 and 10-15 cigarettes per day respectively and 3 (2%) used to smoke 20
or more cigarettes per day. 17 (11.3%) study subjects were smoking for 3-5 years
followed by 14 (9.3%) and 13 (8.7%) were smoking for < 1 year and 1-2 years
respectively and 4 (2.7%) were smoking for 5-10 years. 60 (40%) study subjects

28
were in the age range of 19-20 years, 40 (26.6%) were 18-19 years and remaining
30 (20%) and 20 (13.3%) study subjects were between 20-21 years and more than
22 years respectively. While according to study in Egypt, smoking habits among
family members and presence of smoking peers were significantly associated with
smoking status. Among those smokers 15 (49.66%) used to smoke less than 5
cigarettes per day, 11 (36.42%) used to smoke 5-10 cigarettes per day and 4
(13.2%) used to smoke more than one pack a day. The mean age range of smokers
of Tanta Medical College was between 21 to 25.

Our study showed that 22 (14.7%) study subjects used to smoke to

relieve their tension/anxiety/stress ,14 (9.3%) used to smoke as a fashion and
remaining 8 (5.3%) and 4 (2.7%) used to smoke to enhance their sensory
stimulation and because of their peer pressure respectively. 26 (17.3%) study
subjects doubled their smoking habit, 16 (10.7%) increased their smoking habits 25-
50% more and remaining 3 (2%) quit smoking and did not change their habit
respectively. Whereas in Tanta Medical College, the most common cause of
smoking was stress (42%).

Our study shows That 24 (16%) are Planning to Quit Smoking and 24
(16%) have no plan to quit. 20 (13.3%) Study Subjects Spent <5% on smoking
followed by 13 (8.7%) Spent more than 20% and 9 (6%), 6 (4%) study subjects
Spent 10% and 15% of their Money Respectively. 44 (29.3%) Study Subjects were
aware of harms and dangers of Smoking and Remaining 4 (2.7%) were not aware.
18 (12%) study subject quit smoking because of inflation, 21 (14%) quit due to
counseling and 8 (5.3%) and 1 (0.7%) quit due to antismoking education programs
and placing health warning on cigarette packet respectively. According to study
conducted in Egypt, 37.1% of smokers were willing to quit smoking and 64% of the
smokers were aware of the harms and dangers of smoking.

Overall in the world, about 1 billion men and 250 million women are daily
smokers. In particular 35% and 50% of men and 22% and 9% of women in
developed and developing countries respectively. By 2030 it is thought that about

29
70% of deaths due to smoking are expected to occur is developing countries as the
negative health outcomes of the smoking are serious and being well documented.
Death at earlier age among smokers is more than among non-smokers. About 10
years earlier as compare to non-smokers. College students are at high risk of
smoking as their might be an intimate relation with smoking peers. At the same time,
they are liable to socio-economic and educational challenges when they enter in the
universities.

In a systemic review of literature by Smit and Leggal in 2011, it was shown

that Australia and USA had lower smoking rate among their medical students by 3%
whereas study in Japan in 2012 reported much.

30
 Conclusion
Our study showed that one in five male medical students at Sheikh Zayed Medical
College R.Y Khan were smokers. Moreover, many smokers had their intuition from
their friends. While many of smokers knew about harms of smoking, and few were
planning to quit smoking. It is suggested that appropriate counseling should be
provided to medical students to prevent and control smoking habits among male
medical students.

31
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